Autonomy, information and paternalism in clinical communication

While their paper does not explicitly define the concept of autonomy, the way Ubel et al describe clinicians’ failures to enhance their patients’ autonomy reflects a broader understanding of autonomy than the default account as free and informed choice. In this OPC I would demonstrate that the communication strategies the authors recommend reflects a more sophisticated conception of autonomy than the understanding that typically prevails in bioethics. I will also distinguish between weak and strong forms of paternalism, and argue that a weak paternalistic approach is not only defensible but also aligns with the strategies the authors propose. Thus, by clarifying the concept of autonomy we can show how it can be enhanced in practice

An Epistemic Structuralist Account of Mathematical Knowledge

This thesis aims to explain the nature and justification of mathematical knowledge using an epistemic version of mathematical structuralism, that is a hybrid of Aristotelian structuralism and Hellman’s modal structuralism. Structuralism, the theory that mathematical entities are recurring structures or patterns, has become an increasingly prominent theory of mathematical ontology in the later decades of the twentieth century. The epistemically driven version of structuralism that is advocated in this thesis takes structures to be primarily physical, rather than Platonically abstract entities. A fundamental benefit of epistemic structuralism is that this account, unlike other accounts, can be integrated into a naturalistic epistemology, as well as being congruent with mathematical practice. In justifying mathematical knowledge, two levels of abstraction are introduced. Abstraction by simplification is how we extract mathematical structures from our experience of the physical world. Then, abstraction by extension, simplification or recombination are used to acquire concepts of derivative mathematical structures. It is argued that mathematical theories, like all other formal systems, do not completely capture everything about those aspects of the world they describe. This is made evident by exploring the implications of Skolem’s paradox, Gödel’s second incompleteness theorem and other limitative results. It is argued that these results demonstrate the relativity and theory-dependence of mathematical truths, rather than posing a serious threat to moderate realism. Since mathematics studies structures that originate in the physical world, mathematical knowledge is not significantly distinct from other kinds of scientific knowledge. A consequence of this view about mathematical knowledge is that we can never have absolute certainty, even in mathematics. Even so, by refining and improving mathematical concepts, our knowledge of mathematics becomes increasingly powerful and accurate

Reconceptualizing Autonomy for Bioethics

Autonomy plays a central role in bioethics, but there is no consensus as to how we should understand this concept. This paper critically considers three different conceptions of autonomy: the default conception prevalent in bioethics literature; a broader procedural account of autonomy drawing moral philosophical approaches; and a substantive, perfectionist account. Building on Rebecca Walker’s critique of the default conception of autonomy, we will argue that a substantive, perfectionist approach both fulfils Walker’s criteria for a conception of autonomy in bioethics and lends itself to application in practical scenarios. In so doing, we draw on scenarios from genomic medicine to show that a substantive, perfectionist approach not only offers a more conceptually adequate understanding of autonomy in more complex cases, but also lends itself to practical application by helping health professionals identify how they can maximize people’s capacity to exercise their autonomy

Globalisation and the ethics of transnational biobank networks

Biobanks are increasingly being linked together into global networks in order to maximise their capacity to identify causes of and treatments for disease. While there is great optimism about the potential of these biobank networks to contribute to personalised and data-driven medicine, there are also ethical concerns about, among other things, risks to personal privacy and exploitation of vulnerable populations. Concepts drawn from theories of globalisation can assist with the characterisation of the ethical implications of biobank networking across borders, which can, in turn, inform more ethically sophisticated responses. Using the China Kadoorie Biobank as a case study, we show how distinguishing between the subnational, transnational, supranational and extranational spheres of operation and influence can help researchers, institutions and regulators to understand and manage the ethical issues raised by the globalisation of biobanking.National Health and Medical Research Council (Australia